POS1234 DMARD DISRUPTION, INCREASED DISEASE ACTIVITY, AND PROLONGED SYMPTOM DURATION AFTER ACUTE COVID-19 AMONG PATIENTS WITH RHEUMATIC DISEASE: A PROSPECTIVE STUDY
Authors: M. DI Iorio, C. Cook, K. Vanni, N. Patel, K. D’silva, X. Fu, J. Wang, L. Prisco, E. Kowalski, A. Zaccardelli, L. Martin, G. Qian, T. Hsu, Z. Wallace, J. Sparks
Journal: Annals of the Rheumatic Diseases (2022)

Background Systemic autoimmune rheumatic disease (SARD) patients may be at risk for disease flare and prolonged symptom duration after COVID-19, perhaps related to DMARD disruption and immune activation. Objectives To describe DMARD disruption and identify differences in SARD activity among patients with and without prolonged COVID-19 symptom duration. Methods We identified all SARD patients with confirmed COVID-19 at the Mass General Brigham healthcare system in Boston, USA; prospective recruitment is ongoing. Surveys were used to collect demographics, clinical characteristics, DMARD disruption, COVID-19 course, and SARD disease activity before and after COVID-19. The survey included validated instruments measuring disease activity, pain, fatigue, functional status, and respiratory quality of life. Prolonged symptom duration was defined as COVID-19 symptoms lasting ≥28 days. We compared differences in patient-reported measures between those with and without prolonged symptoms. Results We analyzed survey responses from 174 COVID-19 survivors with SARDs (mean age 52±16 years, 81% female, 80% White). The most common SARDs were RA (40%) and SLE (14%). Fifty-one percent of the 127 respondents on any DMARD reported a disruption to their regimen at COVID-19 onset (Figure 1). Among individual DMARDs, 56-77% were reported to have any change, except for hydroxychloroquine (23%) and rituximab (46%). SARD flare after COVID-19 was reported by 41% of respondents (Table 1). Patient global assessment of SARD activity was worse after COVID-19 (mean 7.6±2.3 before vs. 6.6±2.9 after COVID-19, p&lt;0.001). Prolonged symptom duration was reported by 45% of participants. Those with prolonged symptoms had a higher initial COVID-19 symptom count (median 7 vs. 4, p&lt;0.001) and were more likely to be hospitalized for COVID-19 (28% vs. 17%, p=0.001). Respondents experiencing prolonged symptom duration had higher disease activity on RAPID3 (p=0.007) as well as more pain (p&lt;0.001) and fatigue (p=0.03) compared to those without prolonged symptoms. Table 1. Acute COVID-19 course, SARD flare/activity, and patient-reported outcomes among COVID-19 survivors with SARDs. All COVID-19 survivors with SARDs (n=174 ) Prolonged symptom duration ≥28 days (n=78 ) No prolonged symptom duration / (n=96 ) p-value (prolonged vs. not ) Acute COVID-19 course COVID-19 symptom duration, days, median [IQR] 14 [9, 29] 46 [30, 65] 11 [7, 14] &lt;0.0001 Initial symptom count, median [IQR] 6 [3, 8] 7 [6, 9] 4 [2, 7] &lt;0.001 Hospitalized, n (%) 38 (22) 22 (28) 16 (17) 0.001 SARD flare/activity Self-reported SARD flare after COVID-19, n (%) 71 (41) 38 (49) 33 (34) 0.15 Disease activity by RAPID3, median [IQR] 9 [4, 14] 11.2 [6, 16] 7 [3, 13] 0.0067 RAPID3 categorical score, n (%) 0.13 Remission (0) 11 (7) 4 (5) 7 (7) Near remission (0.3-1.0) 23 (14) 5 (7) 18 (19) Low severity (1.3-2.0) 26 (15) 10 (14) 16 (17) Moderate severity (2.3-4.0) 55 (33) 27 (36) 28 (29) High severity (4.3-10.0) 54 (32) 28 (38) 26 (27) Patient-reported outcomes Pain by SF-MPQ, median [IQR] 2 [1, 2] 2 [1, 2] 1 [0, 2] 0.0008 Fatigue by FSI, median [IQR] 53 [27, 84] 66 [31, 91.5] 43 [26, 76] 0.031 mHAQ, median [IQR] 0.125 [0, 0.38] 0.25 [0, 0.75] 0.125 [0, 0.38] 0.11 Respiratory quality of life by SGRQ, global [IQR] 15 [4, 29] 16 [4, 36] 10 [4, 26] 0.49 RAPID3, Routine Assessment of Patient Index Data 3; SF-MPQ, Short-form McGill Pain Questionnaire; FSI, Fatigue Symptom Inventory; mHAQ, modified Health Assessment Questionnaire; SGRQ, Saint George’s Respiratory Questionnaire. Figure 1. Frequency of baseline DMARD use and proportion with any disruption at COVID-19 onset. Conclusion DMARD disruption, SARD flare, and prolonged symptoms were common in this prospective study of COVID-19 survivors with SARDs. Those with prolonged COVID-19 symptom duration, defined as ≥28 days, had higher SARD activity, more pain, and more fatigue compared to those without prolonged symptoms. These findings suggest that post-acute sequelae of COVID-19 may have a large impact on underlying SARD activity and quality of life. Disclosure of Interests Michael Di Iorio: None declared, Claire Cook: None declared, Kathleen Vanni: None declared, Naomi Patel Consultant of: Receives consulting fees from FVC Health unrelated to this work., Kristin D’Silva: None declared, Xiaoqing Fu: None declared, Jiaqi Wang: None declared, Lauren Prisco: None declared, Emily Kowalski: None declared, Alessandra Zaccardelli: None declared, Lily Martin: None declared, Grace Qian: None declared, Tiffany Hsu: None declared, Zachary Wallace Consultant of: Receives consulting fees from Viela Bio, Zenas BioPharma, and MedPace unrelated to this work., Grant/research support from: Receives research support from Bristol-Myers Squibb and Principia/Sanofi., Jeffrey Sparks Consultant of: Receives consultant fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Gilead, Inova Diagnostics, Janssen, Optum, and Pfizer unrelated to this work., Grant/research support from: Receives research support from Bristol Myers Squibb.